Healthcare Provider Details

I. General information

NPI: 1952564189
Provider Name (Legal Business Name): ASHLEIGH ANNE BRADY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 REGENCY CT
HIGHLAND HEIGHTS KY
41076-1503
US

IV. Provider business mailing address

116 REGENCY CT
HIGHLAND HEIGHTS KY
41076-1503
US

V. Phone/Fax

Practice location:
  • Phone: 859-630-3201
  • Fax:
Mailing address:
  • Phone: 859-630-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM8569
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10764
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number7451
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number254071
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: